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Prolaris Score?

FinishingGrace
Posts: 83
Joined: Apr 2017

I just ran across this website:

https://prolaris.com/prolaris-for-patients/what-is-prolaris/?gclid=CLPw07GQ7tMCFQQxaQodk9EH0g

Has anyone else heard of this or had it done? It proclaims to help someone have a better understanding of the cancers progression which would lead to a more accurate estimate of the outlook for an individual.

We've still never gotten a straight answer from the oncologist regarding a prognosis. Guys here are worried about PSA's of 4, 5, 6, etc. and my neighbors is OVER 600. Has a gleason score of 8 or 9 (can't remember off the top of my head) and metasisis to multiple areas. The oncologist has represented to him that he has 'a long time'. 

 

VascodaGama's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

Yes Grace. It is as you describe. From a gene test one can know on the probabilities of a particular treatment failure or success, before start it. One can give preferences and narrow the choices. We have discussed on the matter here before.

 

FinishingGrace
Posts: 83
Joined: Apr 2017

Thanks Vascoda. I will search for that conversation.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

....to be honest, this test is not appropriate for a man with advanced cancer since the results of will not affect his treatment...the test is appropriate for a man with a lower gleason score, who may wish to consider an active surveillance protocol, or as another tool in determining a localized treatment decision.

Old Salt
Posts: 720
Joined: Aug 2014

I was just trying to compose my response (basically, 'forget about this Prolaris test because your neighbor is way too sick'). But Hopeful was ahead of me, and expressed my view in a nicer way. 

FinishingGrace
Posts: 83
Joined: Apr 2017

I understand the results of the test will not alter treatment, which is palliative at this time. However, would it give a clearer prognosis about the time he has? This is of particular interest since his oncologist will not give any information on prognosis beyond 'you have a long time'...

hopeful and opt...
Posts: 2224
Joined: Apr 2009

...simply look for positive moments to enjoy.....do things that you enjoy.......hang out with positive people

Old Salt
Posts: 720
Joined: Aug 2014

Getting a prognosis should not be a goal at this time. It's simply not possible or realistic.

Your neighbor could live many more years if the taxotere chemotherapy he is currently undergoing is effective without causing major problems. But this is not a given! Let's just hope for the best and reflect on what Hopeful wrote earlier.

FinishingGrace
Posts: 83
Joined: Apr 2017

I appreciate your feedback and Hopefuls, there is truth there. In my experience, with a number of family members facing a variety of terminal cancers it has always been a goal to have some understanding of the time you may have left. Of course, no one can say for certain and doctors are often imprecise in their estimates, but having a prognosis is a reasonable expectation in terms of planning and preparing when facing a terminal illness.

I'm pragmatic in my approach. I can hope for the best and yet still want a realistic view of what is being faced.

I don't understand how having a prognosis is neither possible or realistic and would welcome explanation, not as a challenge but a desire for help to see things more clearly. Thanks.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

A man that I know from a support group that I attend is living with an extensive and aggressive cancer for approximately 15 or 20 years, and is doing well. He is a patient of a world class medical oncologist who specializes only with patients who have prostate cancer.......Now a days there is a geometric progression of drugs that are available to treat advanced disease.

Of course there are different forms of prostate cancer, and all do not experience success in treatment as this man has.

My Mother developed a form of leukemia later in life. This was a different disease, and the doctor knew how much time was left and he told me in private after I asked him. My Mother and Brother did not want to know. This was right for them.

cubsfan1963
Posts: 11
Joined: Jun 2017

Hello Finishing Grace,

I'm new to this forum.  I was diagnosed with PC on May 8, 2017.  I'm 53 years old, in otherwise excellent health.  I had not a physical for a few years and never had a PSA test, so my doc strongly advised that I take it - so I did.  My first result came back as 5.89, then took it again (after a round of antibiotics) and this time it was even higher - 7.09.  Then did a prostate biopsy, and got the sobering news that they found cancer in 7 of 12 cores, and a Gleason score of 7 (4+3).  The pathology report labed my results as "intermediate risk", but the 4+3 score tilted that risk as more aggressive.  So far no signs of extracapsular extension - which is good news as it seems to be contianed to my prostate so far.

I am leaning toward proton therapy, and as part of my consultation with the radiation oncologist at the Chicago Proton Center he suggested that before firming up our plan of attack we should either 1) get a second opinion on my biopsy tissue - and do that at John Hopkins medical center, OR 2) see if my insurance would cover the cost of a Prolaris test - which offers a more definitive look at the biopsy tissue... the findings of which - in combination with a 3T MRI - would enable us to develop the most appropriate treatment plan.

Given the results of my initial pathology report, I was not shocked when my Prolaris test score came back as high... it was 4.3, and labeled "more aggressive".  As a result, my doc is recommending that I do a short term hormone therapy (approx 4 months), and start the proton therapy after I'm about a month and a half into the hormone therapy.

After everything I've read about hormone therapy I really don't want to do it.  I prefer to dive right into the proton therapy and take my chances, as to me, the quality of my life is just as important as the quantity of my life.  I will be talking to my doc tomorrow to see if that's an option.

The Prolaris test is expensive, but apparently my insurance covered it.  If you have the option to do it, you probably should.  It does take about two weeks from the time your doc requests it until you get your results back, FYI.

If you have additional questions, please don't hesistate to ask.

FinishingGrace
Posts: 83
Joined: Apr 2017

It is unlikely that my neighbor, who is on full disability at this point and medicaid, will be able to get the test covered. I do plan to ask. Either way he's already started chemo and HT. 

A close friend was an oncology nurse at a proton center where I live. Her opinion is that proton therapy is by far the best and most successful weapon against prostate cancer.

cubsfan1963
Posts: 11
Joined: Jun 2017

Proton beam therapy certainly seems to have the biggest and most focal fan club, for what that's worth.  I've been very impressed by protonBOB/brotherhood of the balloon website, as well as Bob Marckini and his book, "You Can Beat Prostate Cancer... and you don't need surgery to do it."  All of the survivor stories on that site, plus his book, have really shaped my thinking in terms of the treatment path I plan to take.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

Cubfan, I wonder, did you in fact have a 3T MRI? This test can be an indicator of extracapsular extension.

cubsfan1963
Posts: 11
Joined: Jun 2017

Haven't had an MRI yet.  For proton therapy, they first insert 3-4 gold fidicual markers in the prostate, along with the hydrogel spacer (that is inserted in the space beween the prostate and rectal wall... it dissolves within 4-6 months).  They then do the 3T MRI to both confirm exact placement of the markers and spacer, and to get high definition images of the prostate (with and without contrast).  However, the doc said that if i do the neoadjuvant hormone therapy, they would get that started first (ASAP I suppose), and then do the marker/spacer placement and MRI about six weeks later... and immideately initiate the proton therapy.  Sounds like my treatment length for protons would be 28 sessions spread over 5 1/2 weeks.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

I was referring to this image test as a diagnostic tool, so you can make the best decision on your choice of therapy(s), to be done before any treatment, not part of a treatment. VG also mentioned having another image test as well.......selecting a PET SCAN such as a gallium 68 pet scan prostate, the combination of the two type image tests provides "best" knowledge available about the location of the cancer.

 

 

cubsfan1963
Posts: 11
Joined: Jun 2017

I was initially supposed to have a 3T MRI after my consultation with a radiation oncologist at the hospital where I had my biopsy (met with him on referral from my urologist)... and for the exact reason you state above - to confirm whether or not there's any extra capusular extension, etc., so we could confirm my treatment plan.  The doctor at the proton center will use it to do the same... but it does seem like their desire to combine that with confirmining placement of the fiducial markers and hyrdogel does put the cart before the horse, so to speak.  Their logic is that I likely can only have one MRI covered by my insurance, so might as well do all of that at once.

I need to ask about that PET scan to see if i might be eligible to have it done...

hopeful and opt...
Posts: 2224
Joined: Apr 2009

I believe that for SBRT, CT Scan is sufficient and used to place markers. (Those who have had SBRT can comment on this statement). This may be true for proton bean as well.....so 3T MRI diagnostic to determine what is going on and the best active treatment; then a ct scan to place markers.

By the way studies have shown that while being more expensive,proton bean is no better than  any other type of radiation.

There are  centers that administer the preferred newer generations of proton bean that you need to investigate ifor this type treatment. 

Also as mentioned before, consider SBRT.

There are top centers of excellence in Chicago that you may consult with.

 

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